Korean J Neurotrauma.  2018 Oct;14(2):112-117. 10.13004/kjnt.2018.14.2.112.

Risk Factors of Delayed Intracranial Hemorrhage Following Ventriculoperitoneal Shunt

Affiliations
  • 1Department of Neurosurgery, Seoul Medical Center, Seoul, Korea.
  • 2Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea. kch5142@hanyang.ac.kr

Abstract


OBJECTIVE
Placement of a ventriculoperitoneal (VP) shunt is a common neurosurgical procedure for cerebrospinal fluid diversion. A rare complication is delayed intracranial hemorrhage (ICH) secondary to VP shunting, and only a few patients with this complication have been reported. We investigate the incidence and risk factors of delayed ICH development following VP shunt placement.
METHODS
Over an 11-year period, 167 patients received a VP shunt for hydrocephalus, and of these, 138 patients were eligible for this study. All medical records and computed tomography scans obtained within 48 h after the operation and at postoperative day 7 were reviewed. The risk factors of developing delayed ICH (≥48 hr after VP shunt placement) were analyzed according to the demographic data, including sex and age, original intracranial lesions, co-morbid diseases, and laboratory findings.
RESULTS
Delayed ICH following VP shunt placement developed in 34 (24.6%) of the 138 patients. Risk factors for developing delayed ICH were age (p=0.037) and the partial thromboplastin time (PTT) (p=0.032). Intraventricular hemorrhage after VP shunting was the most common complication, occurring in 16 cases. Hemorrhagic volume was < 1 mL in 28 cases and >1 mL in 6 cases.
CONCLUSION
This study suggests that old age and delayed PTT are major risk factors for developing delayed ICH following VP shunting. Additionally, delayed ICH after VP shunting commonly occurs even when most patients are asymptomatic. Therefore, extra care should be taken to observe and follow-up with patients who have undergone VP shunt placement.

Keyword

Hydrocephalus; Intracranial hemorrhage; Risk factor; Ventriculoperitoneal shunt

MeSH Terms

Cerebrospinal Fluid
Follow-Up Studies
Hemorrhage
Humans
Hydrocephalus
Incidence
Intracranial Hemorrhages*
Medical Records
Neurosurgical Procedures
Partial Thromboplastin Time
Risk Factors*
Ventriculoperitoneal Shunt*

Figure

  • FIGURE 1 Illustration of case 1. (A) Intracranial hemorrhage (ICH) was not developed on the postoperative day 1 after ventriculoperitoneal shunt. (B) Delayed ICH along the path of the catheter was developed on the postoperative day 7.

  • FIGURE 2 Illustration of case 2. (A) Intracranial hemorrhage (ICH) was not developed on the postoperative day 1 after ventriculoperitoneal shunt. (B) Delayed intraventricular hemorrhage was developed on the postoperative day 3. (C) No intraparenchymal hemorrhage was seen in along the path of the catheter. (D) Another ICH was developed on the postoperative day 7.


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